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Saturday, June 4, 2011

Here comes the asthma

So it happened, a few weeks ago: Voov showed the first signs of developing asthma. We were always aware that she might, because eczema runs in the family and my sister has eczema and asthma, and asthma is the final part of the famous Atopic Triad. Still, it is a bummer to see your two-year-old with a rubber mask over her face taking her twice-daily dose of an inhaler.

Voov had had a cold, and was in for a checkup, and the doctor noted that she had a slight wheeze; her blood oxygenation was at 95%. So, with her history, the doctor tentatively diagnosed asthma and sent her home with the inhaler and a special mask. Voov was initially pretty excited about the attention, but after a few days, applying the inhaler took two adults, one to straitjacket the kid and the other to handle the inhaler.

Then she got better or at least well enough that she didn't have a wheeze. For now, the inhaler's packed away. Voov is healthy and upbeat and I think she'll cruise right through childhood just fine even if she has to carry an inhaler with her.

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I thought I'd mention this great review I read recently titled "Epidermal Barrier Dysfunction in Atopic Dermatitis." It's from 2009 and provides an encyclopedic view of how known genetic factors are related to the breakdown of the skin barrier, and how many factors such as pH and enzymes and antimicrobial peptides are involved. It also has an interesting section toward the end featuring this graphic

with an accompanying explanation of how it is that many more kids than adults have eczema, and how the condition improves with age for the lucky majority. Basically, when we're newborn, our skin barrier is terrible, the worst it'll ever be. In the first few years of childhood, the quality of our skin improves. In those people who have minor genetic defects that affect the skin barrier, eczema develops early on but fades away as the skin improves past some threshold. People with serious genetic defects like major filaggrin mutations never see their skin improve past the threshold, so they never escape eczema.

At least that's how the authors put it. It's a pretty hand-waving theory. For one thing, many scientists think that a poor skin barrier lets in pathogens and allergens that trigger a heavy immune response early on, and that this response imprints a permanent memory in the body (in the form of antibodies) that powers reactions to certain foods. So if this "memory" is made early on in the 20% of kids who have eczema, why does it go away for most of them after the skin barrier improves?

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One final item: Anacor Pharmaceuticals has begun phase 2 clinical trials of two novel anti-inflammatory ointments for treatment of eczema. The two compounds are boron-based (this is unusual) and have shown promise for treating psoriasis in more advanced clinical trials. For a thorough comparison of psoriasis and eczema, see the most recent JACI Journal Club, which discusses a two-part review paper on the topic.

7 comments:

Hi there- Always love your blog- you put in a lot of effort , and it shows. I have a question for you that I hope you might answer (and I need the opinion of a science based person- I have many opinions of alternatve medicine- and I need someone to correct my findings if this is wrong) After much research, it seems as though our vaccinations may be causing other hypersensitivities. It has been years been the case that alumimum has been used to sensitize animals to particular allergens- (injecting aluminum with the allergen in question creates the body's response to that allergen) an example herehttp://jap.physiology.org/content/96/4/1433.full

and for years scientists have cause anaphylaxis in animals by doing these injections- or some kind of hypersensitivity that is allergen specific. Now we use aluminum in most vaccines as an adjuvant to help make the vaccine stronger. My question is- these vaccines also have casein, egg components, bovine serum, soy proteins, MSG.Why wouldn't the person be sensitized to some of these proteins too? they are in same shot, admininistered at the same time? These kids have so many allergies these days (excema, asthma, anaphylaxis) what do you think of that connection?I would love to hear your imput.kind regards,Stephanie

Stephanie, great question. I'm no vaccine expert but as a parent I feel that the benefits of being vaccinated greatly outweigh the risks. That said, you make a good point. I looked here http://www.vaccinesafety.edu/components.htm for a quick idea of what's in common vaccines. I was interested to see that all of the vaccines that I looked at that had adjuvants (usually aluminum phosphate) did not contain allergens such as egg or milk proteins. Only the influenza vaccine contained the egg protein ovalbumin, and it did not come with an adjuvant.

The virus and bacteria used to make the vaccines are probably grown in media containing bovine serum, and it is possible that there are trace amounts of this in the vaccines. But with vaccines, my naive expectation would be that the amount of allergen in the vaccine matters, and if there's only a trace amount (so small it isn't detectable) then it probably wouldn't induce a strong immune response.

It looks like most vaccines have some sort of adjuvant- mostly aluminum in different forms - you talked about aluminum phosphate, there is another one aluminum hydroxide that they talk about in a lot of studies sensitizing lab animals, and you find it in many vaccines. In the dtap there is this adjuvant with variations of bovine extract, bovine protein, protein serum, etc and also lactoalbumin (found in most basic mammal milk) among others. there are chicken fibroblasts, and many vaccines with this adjuvant and soy proteins and yeast proteins. If we are injecting this, and we are giving babies mulitple innoculations at one time- which we do, I have witnessed several kids get 5 shots in one day. wouldn't there be quite a bit of aluminum floating around, which even though it wasn't in the same shot(but alot of times it is) but in the shot you get in the next minute, couldn't that cause some sensitivity? These studies they induce asthma into animals by giving them these shots with the adjuvant, and then exposing them to that allergen again. It is curious why these kids are so allergic to all these basic foods that didn't happen when we were growing up. I see kids all around that have such bad exczema, asthma, and they can't eat anything.To be clear I am pro vaccination. I have had my shots growing up, and glad that we have gotten rid of the scourges that we have. I will vaccinate my children- but I have watched my niece on the road to 36 vaccines (5 in one day!) - and I had 10 total. I am just wondering if some of this has to do with some of this asthma/eczema/allergies nightmare that has seemed to really grow in the last 20 years. There doesn't seem to be many studies on it, and it is a huge problem- Again- your non-expert but your informed and science minded imput would be highly appreciated.thanks!Stephanie

oh yes one more thing from our comment- if there were multiple shots with multiple doses of both the aluminum and the allergen, wouldn't that increase the possible reaction? and then possibly a reaction the next time the baby came into contact with it? also if you become allergic to yeast protein or soy protein, anytime there would be yeast protein or soy protein (which is in most packaged food for sure) you might have a reaction? but would make it difficult for a person doing an elimination diet,especially with yeast? thanks!

All of your points are good ones. Makes sense that you might develop an immune reaction (that is, antibodies & T cell receptors) to whatever foreign protein you're injected with, especially if it comes with an adjuvant. My guess is that the material in the adjuvants has been chosen and adjusted over time as large scale studies have shown what causes major problems. (I wouldn't want to have been in the first round of people ever getting these vaccines!) And it does seem to be true (I have not seen any hard data though) that kids are getting more vaccines, and more of them bunched together. My daughter has had a number of simultaneous multi-vaccinations and we're always a bit worried that the impact might be a bit too much. But there must be studies out there showing that, on a population scale, it's OK to give vaccinations on this schedule. There will always be some kids who have adverse reactions of various types.

So what to do? Would seem to make sense to get the vaccines but perhaps spaced out more if you can manage it. I hesitate to say anything more because 1) immunology is damned complex 2) there are many risks in life and you have to try to prioritize 3) the only proof of increased atopy caused by vaccines is going to come from multiple large scale population studies, which take years, etc.

It is entertaining to speculate, but in science the way it works, or should, is that you speculate for a while until you get a really good question that you can design a test for. Someone may have already done some tests that answer your questions--have a look on PubMed if you haven't already. Just don't cherry-pick your search to find only those studies that say what you want them to!

As for increasing numbers of kids with allergies etc., there are many factors that could be responsible, including increased numbers of diagnoses; indoor, urban lifestyle; more artificial diet; artificial materials such as petroleum-based interior furnishings. Vaccines are likely a factor to some degree, but who knows how large?

I agree with you we are surrounded by so many other toxins these days- and it could be a host of many things.So many things actually- plastic, chemicals, yikes!Although I do have hard proof that we have many many more vaccines than we ever had, and they are given in greater quantities per "well baby" visits.To tell you the truth, I had written a whole diatribe earlier- too long to post, and just erased it.I just wanted to to get to the point- really. I have always been a believer in Western medicine and science, it is good for us and has benefited us beyond measure- but I think from a couple HUGE personal experiences in the last year or so (2 instances of close friends and vaccines resulting in autism- and another instance terrible terrible eczema seemingly after multi shot vaccines-plus just lots and lots of kids with eczema), and a general re- evaluation,with lots of research (because quite honestly I don't want to believe that there could be a connection)- and reading the Simpsonwood transcripts, and then researching these studies on aluminmum causing atopy/sensitivity - and seeing the connnection of aluminum in our vaccines- I am shaken. I feel like I have been told there is not only there is no Santa Claus but the guy you though was SC is actually he has been poisoning you. I respect your opinion, spanish key- I have followed your blog for months. But there is definitely a dead canary in the coal mine and I know immumology is very complex, but if we don't ask the questions, and wait for some scientists (not you of course ;) who are influenced by the pharmaceutical companies to do something , it may even be longer. I know vaccination is important-like I said -I will vaccinate, and think people should, or most should-but I don't see any studies that are comparing there safety in combination or increased numbers. I feel like we are setting some kids up for disaster. Would you feel any different if you knew that a vaccine or combo was causing your eczema? Would you have forgone it for your self if you had the option? would you have forgone any for your children if you knew there was a connection? At least by putting together what i have (as a total layman, and I am for sure not the only one to connect them) - does it make you curious if there is a connection? I am curious if you in your work (phd and scientist) circles,ever connect the two, especially with your interest in eczema? maybe if we found out the cause (or one of them anyway), we could alter it and we could really end eczema? what do you think?kind regardsStephanie

I count myself lucky that I can approach this topic without emotion. Nobody in my family has developed a severe condition in the period following a vaccination, when one might suspect the vaccine was the cause.

You may have seen this story in Nature--if not, it's worth reading.http://www.nature.com/news/2011/110525/full/473436a.html#B1 Basically, my take is that there IS a careful awareness in the scientific community about risks from vaccines--especially severe life-threatening risks. These are at least easier to connect with vaccination. Food allergies and eczema are not. Eczema often goes un- or mis-diagnosed; non-anaphylactic food allergies are notoriously difficult to diagnose. Connecting them to vaccination would be extremely difficult. There are some studies out there, e.g for something called the BCG vaccine (no connection found) http://www.ncbi.nlm.nih.gov/pubmed/20933258 and the measles vaccine (a POSITIVE connection found, in that vaccination reduced incidence of atopy) http://www.ncbi.nlm.nih.gov/pubmed/19255001 and probably a lot more to be found if one had the time to search.

I unfortunately do not have the time to discuss this topic further--I don't have much free time for the blog! but let me say this: I do have hope for a personalized genetic approach that could identify risks and produce a vaccine schedule for individuals.

You ask "Would you feel any different if you knew that a vaccine or combo was causing your eczema?" and I suppose I would. But nobody KNOWS, and in my case I'm pretty sure it's a genetic inheritance, based on my family history. "Would you have forgone any for your children if you knew there was a connection?" Possibly, depending on the disease--but at the moment the question is speculative because there are no well-established connections. "Does it make you curious if there is a connection?" Yes, and something I will follow up on if I can. Please list any valuable references you find.